Provider Demographics
NPI:1417997313
Name:HUGHES, LISA M (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 BAILEY ST NW
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3613
Mailing Address - Country:US
Mailing Address - Phone:330-837-3823
Mailing Address - Fax:330-837-8313
Practice Address - Street 1:3300 BAILEY ST NW
Practice Address - Street 2:SUITE 104
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3613
Practice Address - Country:US
Practice Address - Phone:330-837-3823
Practice Address - Fax:330-837-8313
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50000497363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH970022370OtherRAILROAD MEDICARE
OH970022370OtherRAILROAD MEDICARE
S56848Medicare UPIN